Promoting Recovery-oriented Mental Health Services Through a Peer Specialist Employer Learning Community

Lynda Frost; Tammy Heinz; Dennis H. Bach


J Participat Med. 2011;3 

In This Article

Abstract and Introduction


Recovery-oriented mental health services — those in which consumers actively participate in selecting services and developing treatment plans while working toward recovery — are increasingly viewed as more effective and efficient than the traditional medical model. In recent years, national organizations have identified gains made possible by active, engaged consumers of mental health services. Certification programs for peer specialists to learn to provide peer support are an established vehicle for empowering consumers, but many service providers are unsure of how to include peer specialists in their organizations and may be skeptical of their value. This case study describes an employer learning community model for providers and consumers to explore, through a team approach, the value of having consumers in peer specialist roles and the importance of recovery-oriented practice. The peer specialist employer learning community has shown to be a promising method to guide organizations through the process of adopting a recovery model of service provision with certified peer specialists in meaningful, effective roles.


The traditional medical model of mental health service delivery in the United States "focuses on the defect or dysfunction within the patient,"[1] using highly trained professionals diagnosing and treating passive service recipients. This model has generated expensive care with moderate results and longstanding shortages within the mental health workforce.[2] Even more challenges exist in accessing quality up-to-date care and the best support services, including a long delay between new scientific discoveries and their use in practice, limited funding and budget reductions, workforce shortages, and the unintentional encouragement of long-term care in mental health treatment.[3]

These results and challenges have led key national groups to call for a full transformation of the system that delivers mental health services in the United States.[2–5] According to the President's New Freedom Commission final report, successful transformation rests on services and treatments that are consumer- and family-centered with real and meaningful choices and care that is focused "on increasing consumers' ability to successfully cope with life's challenges, on facilitating recovery and on building resilience, not just on managing symptoms.[4]"

Recovery from mental illness is a relatively new concept. A national consensus statement developed by over 110 mental health consumers, family members, providers, advocates, researchers, academicians, managed care representatives, accreditation organization representatives, state and local public officials, and others concluded that "mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.[5]" Recovery-oriented services instill hope that recovery is possible and that mental illness does not have to be lifelong or chronic. They empower consumers to take personal responsibility for their wellness and include consumers in decisions that concern them. They educate consumers that mental illness is only a piece of who they are and consider their individual goals in treatment, rather than simply managing symptoms. They include community outreach to decrease isolation as well as more traditional services (eg, medication management, therapy, crisis hotlines, and employment support), all offered with the belief that recovery is possible.[6] The President's New Freedom Commission identified recovery as the most important goal of the people served by the system.[5]

For many consumers, an important component of recovery is finding meaning and significance in their personal experience with mental illness. Often, consumers find a fulfilling role in the provision of support to their peers in natural or formal settings.[7] The incorporation of peer specialists, ie, individuals who self-identify as persons in recovery from mental health issues and are trained to work with fellow consumers by providing education, advocacy and support,[2,4,5,8] empowers consumers of mental health services and is a crucial component of a recovery orientation.[9]

Limited numbers of peers have worked in paid positions with mental health providers for several decades.[9–12] Their roles have varied, ranging from advocate to peer counselor, treatment team member, support group leader, educator, personal coach, resource navigator, or evaluator.[13–16] They faced barriers from colleagues such as lack of trust, exclusion, role confusion, lack of respect, and fear of their fragility in terms of workload.[13,14,17] They also faced personal challenges such as isolation, dual relationships, low pay, and lack of a career ladder.[13,17,18,9]

Preliminary research on peer support was mostly qualitative and anecdotal, but it indicated that the approach was feasible.([19] Random controlled trials of peer support for adults with depression showed superior results when compared to usual care alone and comparable results to group cognitive behavioral therapy.[20] Gradually, the role of peer specialists has become more widely accepted in the mental health community.[21] Over the last decade, states and providers have identified funding sources, especially Medicaid, for many peer support services.[22] This led to an increase in the number of training programs leading to certification as a peer specialist and higher demand for peer support services.[21]

Today, in a departure from traditional mental health services, certified peer specialists play an essential role in some service environments. While certified peer specialists' job descriptions are dependent on the environment in which they are employed (eg, state hospitals, community mental health centers, and consumer-run clubhouses), their approach entails a new and more participatory role for consumers in their own treatment goals and services, as well as the opportunity to advocate for and support their peers.[23] A primary difference in approach is that in addition to traditional knowledge and competencies, peer specialists use their lived experience and experiential knowledge.[12,24] A certified peer specialist lives recovery, often using language based upon common experience rather than clinical terminology ([19] The use of peer specialists as part of the treatment team has been shown to have favorable results.[18,25] Often, information that peers obtain during peer support is viewed as more credible than that obtained by mental health professionals.[26] When peers are part of hospital-based care, the "results indicate shortened lengths of stays, decreased frequency of admissions, and a subsequent reduction in overall treatment costs."[3] Other studies suggest that using peer support can reduce the long-term need for mental health services.[3,27,28]

This case study describes the evolution of a statewide employer learning community for employers of peer specialists in Texas and the experiences of participating service providers. It summarizes outcomes from the first-year employer learning community and resulting changes made for the second-year employer learning community. It traces the evolution of consumer roles during this process and describes how, in order for consumers to be active participants in their recovery, service providers must shift their culture from a traditional medical model to a recovery-oriented focus. It concludes that a process dedicated to this shift, like the employer learning communities implemented in Texas, can facilitate a faster and more successful change.